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目的 :探讨腹腔镜处理晚期胰头癌胆总管下端梗阻的适应证和并发症。方法 :采用腹腔镜胆总管探查(Laparoscopiccommonbileduetexploration ,LCDE)结合美国BARD公司产胆道扩张导管、胆道内涵管、耐高压球囊导管和BOSTON公司产斑马导丝施行胆总管下端扩张术 (Laparoscopicpapillaryballondilation ,LPBD) ,扩张满意 ,放置胆道内涵管 ,胆管切口 4～ 0或 5～ 0可吸收缝线即时缝合 ,其他情况放置胆道内涵管内引流同时放置T形管外引流。Winslow孔附近常规放置腹腔引流管观察渗漏情况。结果 :9例中 7例手术获成功 (胆道内涵管引流通畅、黄疸减轻或消退 ) ,1例中转开腹放置胆道内涵管同时放置T形管外引流 ,1例术后 15d死于胆道感染诱发肝肾功能衰竭。无胆漏 ,术后从腹腔引流管引流出渗出液 2 0～ 30 0ml,1～ 7d后停止。术后1d进少量流汁 ,术后 2～ 9d拔除腹腔引流管 ,术后 3～ 7d间断或连续夹闭T形引流管 ,术后 3～ 15d出院。术后 2个月逆行胆道造影胆道内涵管引流通畅后拔除T形引流管。结论 :选择合适病例采用腹腔镜胆道内涵管引流术处理晚期胰头癌胆总管下端梗阻这一术式是安全可行的。
Objective: To investigate the indications and complications of laparoscopic treatment of advanced common bile duct obstruction in patients with pancreatic head cancer. Methods: Laparoscopic common bile duct catheterization (BIPD) was performed by Laparoscopic common bile duct drainage (LCDE) combined with biliary dilatation catheter, biliary tract endoprosthesis, endarterectomy balloon catheter and BOSTON zebra guide wire in American BARD. Expansion of satisfaction, placing the biliary tract of intestine, bile duct incision 4 ~ 0 or 5 ~ 0 absorbable sutures immediately sutured, otherwise placed within the biliary tract drainage catheter placed at the same time T-tube drainage. Peritoneal drainage tubes were routinely placed near the Winslow hole to observe the leakage. Results: Of the 9 cases, 7 cases were successful in surgery (drainage of biliary tract and drainage tube and jaundice relieved or subsided). One case underwent laparotomy with bile duct drainage and drainage of T tube. One case died of biliary tract infection 15 days after operation Liver and kidney failure. No bile leakage, after drainage from the peritoneal drainage tube exudate 20 ~ 30 0ml, 1 ~ 7d after the stop. A small amount of juice was dosed 1 d after operation. The abdominal drainage tube was removed 2 to 9 days after operation, and the T-shaped drainage tube was intermittently or continuously occluded 3 to 7 days after operation and was discharged 3 to 15 days after operation. 2 months after retrograde cholangiography biliary drainage tube drainage unobstructed T-shaped drainage tube. Conclusion: It is safe and feasible to choose the appropriate case for laparoscopic biliary drainage in the treatment of advanced common bile duct obstruction.